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CHOCTAW ASSET BUILDING IDA PARTICIPANT APPLICATION P. O. Box 1210 Durant OK 74701 580 920-2260/ 580 920-0453 FAX APPLICANT/PARTICIPANT DETAILS HEAD OF HOUSEHOLD Last Name Y / N First Name Initial Last four digits of Social Security Number Phone Tribe Cell E-mail Street Address Mailing Address City and State Zip Code Emergency Contact Name County Mailing Relation ZIP Code Currently Eligible Currently Receiving Has Ever Received Yes No Federal EITC.

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